Information Collection Request
Affordable Care Act Internal Claims and Appeals and External Review Procedures for Non-grandfathered Group Health Plans and Issuers and Individual Market Issuers (CMS-10338)
ICR 202504-0938-011 · OMB 0938-1099 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0938-1099 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 CMS-10338 - Non-sub Change Request Memo Appeals.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2025-04-10 | Repair queued |
| CMS-10338 - Crosswalk of changes to Appeals - .docx |
Supplementary Document | Uploaded 2025-04-10 | Repair queued |
| Non-sub Change Request Memo (CMS-10338_Appeals PRA)_clean.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2024-12-12 | Missing upstream |
 CMS-10338- 60-day Comments Response Summary_FINAL.pdf |
Supplementary Document | Uploaded 2022-05-09 | Repair queued |
| CMS-10338 - Supporting_Statement_2022_Final.pdf |
Supporting Statement A | Uploaded 2022-05-09 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 249636 |  Internal Claims and Appeals and External Review Procedures |
Unchanged | ||
| 193861 | Burden Estimates - Appeals |
Other-Model - Notice of Internal Adverse Benefit Determination | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CMS |
| OMB Control No | 0938-1099 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202412-0938-009 |
| Agency Tracking No | CCIIO |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |